We found no clear evidence of the clinical superiority of distal radius fracture surgery among older adults at one year. Surgical treatment, however, may yield a faster recovery to previous level of activity in elderly patients. With operative treatment, hardware-based problems may warrant secondary operations and implant removal, whereas in non-operative treatment, symptomatic loss of alignment and malunion can occur. In elderly patients, non-operative treatment can be considered to be the gold standard. Cite this article: EFORT Open Rev 2020;5:361-370. DOI: 10.1302/2058-5241.5.190060

BackgroundDistal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients. Methods and findingsWe performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65-94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.-3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16-2.1). ConclusionIn this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly

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Background The aim of this study was to assess the sensitivity of distal biceps hook test – O’Driscoll hook test – in a retrospective series of acute and chronic distal biceps tendon tears and investigate the ability of the test to predict the need for graft reconstruction. Methods We retrospectively evaluated 234 consecutive distal biceps tendon tears operated in a single centre. The result of O’Driscoll hook test and perioperative findings of distal biceps were documented in standard fashion. Results The perioperative and O’Driscoll hook test data were available in 202 cases. The sensitivity for the distal biceps hook test was 78% in all tears and 83% in complete tears. The sensitivity was significantly lower in partial tears (30%) and in cases where lacertus fibrosus was found to be intact (45 %). When O’Driscoll hook test was positive and the delay from initial injury to operative intervention was eight weeks or more, there was over 75% probability of achilles tendon allograft reconstruction. When O’Driscoll hook test was negative, the probability of reconstruction even after 12 weeks’ delay was only 20%. Discussion O’Driscoll hook test is useful when establishing distal biceps tendon tear diagnosis, but a negative test does not exclude rupture. In delayed cases, a positive test may predict the need for reconstruction.